I ACLs Anesthesia Centric A Department of Anesthesia and Perioperative Medicine Publication

In This Issue
Message from the Editor
GRAND ROUNDS LIVE
The Global Health Project
NEW PGY1’S
ANNOUNCEMENTS
A Department of Anesthesia and Perioperative Medicine Publication
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Pg 5
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Spring 2014
A nes t h es i a C e n t r i c AC Ls
I
t is with great pleasure that I report
that the long awaited, Anesthesia
specific, Advanced Cardiac Life
Support Simulation Course is now up
and running. To date, we have conducted
three courses, each with eight individuals, in addition to a course for the PGY-5
residents. The feedback from participants
after completing
the online review of
material, followed
by an involved
simulation session,
has been great. At
present, there are
10 scheduled courses a year, based on a
3 year cycle (which
means that one
should participate
in a course every
three years).
The road to get
here has been a
long one. It is not
easy to plan and
coordinate a course
for an entire city of
Anesthesiologists. Especially when there
is a prior course pre-requisite (Basic Life
Support), developing scenarios which
reflect, and are relevant to our day to day
practice, applying for MOC credit, and
coordinating Instructors’ schedules. I
Dr. Kelvin Williamson
put out a very big “thank you” to everyone
involved.
The first step was to deliver a city wide
BLS recertification, to ensure eligibility for
ACLS. This was achieved by providing didactic material on our website for review.
Any participant also had the option of
reviewing the BLS provider manual. Next,
BLS Instructors, a number of our ACAs,
provided AEDs and Mannequins on site at
each centre, for hands-on demonstration
of the skills.
Following this, ACLS Instructors and
Simulation experienced staff coordinated
efforts to come up with a set of scenarios
which reflect situations that Anesthesiologists see day to day. Finally, the last step
was to jump in and conduct the course.
The course is based on, and extrapolated
from the traditional ACLS program. All of
the elements of
the traditional
course are present, but with a
peri-operative
perspective. As
we all know,
the traditional
course is fairly
generic in its
approach and,
in all reality, caters to primary
care specialists.
Quite often,
Anesthesiologists see malignant arrhythmias which
are caused by
conditions or
events which the traditional course does
not include in their differential diagnosis.
Anesthesiologists are essentially left to
treat two issues at once; the arrhythmia,
and the precipitating cause. Therapies, at
times, may also need to be adjusted
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M es s ag e f ro m T h e D e pa rtme nt He ad:
W
e are indeed
happy that
Gaslines has
emerged from hibernation. I
am delighted to welcome Dr.
Amit Chopra as the new Editor
of Gasline and thank him for
his willingness and enthusiasm
in restarting the publication.
Amit is ably being assisted by
Bruce Knoll and Sean Jardine.
As many of you are aware,
the Faculty of Health Sciences
is now a reality at the University of Manitoba. This initiative
was undertaken by the University of Manitoba President’s
Office in order to streamline
the number of faculties within
the University of Manitoba.
The Faculty of Health Sciences
resulted from the larger University of Manitoba initiative
to merge the functioning of
faculties around areas sharing
common teaching, education,
research and practice. As
a result, the new Faculty of
Health Sciences consists of
five member Colleges which
include Dentistry, Medicine,
Nursing, Pharmacy and
Rehabilitation Sciences. The
goal of the Faculty of Health
Sciences is to promote collaboration amongst these various
disciplines, and evolve the way
students are taught. It is anticipated that Interprofessional
Education (IPE), as learners
learn together, will become a
cornerstone of the functioning of the Faculty of Health
Sciences. As anesthesiologists,
we have had a leadership role
over the years in IPE and have
been pioneers in areas such as
simulation, which is one of the
best ways of teaching IPE.
Although the major focus of
these academic restructuring
initiatives have focused on
the realignment of faculties,
a question often addressed to
Department Heads is “what
will be the implication for the
current department structure
of medical colleges”? It is
fair to postulate that there are
likely no major implications
for departments in the near
future, but that embracing IPE,
teaching, research and clinical
care will be something that
will continue to be required in
modern health care delivery.
I see these changes as opportunities and not as threats to
Departments of Anesthesia.
Another important development
in the College of
Medicine has been
the reorganization
of the Med 1 to 4
curriculum. Many
of the changes in
the curriculum have
tried to incorporate a
more longitudinal
ap-
Dr. Eric Jacobsohn
proach to student learning,
modern teaching modalities
(such as simulation), as well as
an increased integration of IPE.
The Department of Anesthesia contributed significantly
to the curriculum renewal
process; I thank all of you who
contributed! As things stand
regarding our contributions to
the medical student education,
we undoubtedly have a robust
Clerkship Program; that is
well-rated by the students. The
Department appreciates the
faculty efforts in the clerkship
and understands that a full day
of teaching in the operating
room, while challenging, is also
extremely rewarding. However, in addition to clerkship,
medical students have over
2,000 hours of Pre-clerkship
instruction. In this area,
we currently have a
small footprint. We
have identified this
as an opportunity
to further our
role in curriculum, and in many
ways, it is our obligation. Medical
schools are
in-
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creasingly expecting that the
curriculum, at all levels, is
delivered by the faculty from
all disciplines. In addition
to making a difference in the
education of medical students,
we will have opportunity to
showcase our knowledge and
skills, and potentially sow the
seeds in some that will eventually become our residents and
future colleagues.
We had another successful
CaRMS match this year. The
CaRMS process continues to be
one that engages many members of the faculty, involves a
tremendous amount of work
by many committed people.
The CaRMS process resulted
in 80% of Manitoba students
matching within the province. This represents a record
retention rate for the province
and exceeds the 75% goal set
by the Dean of the College of
Medicine two years ago. Of
course, the debate on the right
percentage will continue for
years i.e. offering opportunities to local medical students
versus “cross-pollination” with
medical students from other
provinces. Other provinces
are grappling with the same
issue. As Canadians we value
portability opportunities
within Canada, but also
understand that it is
affected by fundors at the
Provincial level. In addition to the aforementioned opportunities,
significant challenges exist as well. The College
of Medicine has been
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Gas l i ne: W e lc o m e Bac k !
A
s co-editor of the Department of
Anesthesiology and Perioperative Medicine Gasline newsletter,
I would like to welcome all readers to our
re-launch for the spring/summer season.
When I was approached about helping restart Gasline, the idea seemed interesting.
The University of Manitoba, Department
of Anesthesiology and Perioperative Medicine is one of the biggest, most diverse
departments in the University of Manitoba
Faculty of Medicine. It plays a fundamental role in providing a high standard and
expansive service of clinical care, medical
research and education. From teaching medical students, training residents
and fellows to a vibrant and productive
research program as well as providing
a broad clinical service base from adult
general anesthesia to critical care, pain
medicine and various other subspecialty
Dr. Amit Chopra
disciplines, our department is a vital asset
to our faculty of medicine, city and province. It is with this thought that I wanted
to help relaunch Gasline, to showcase the
accomplishments and vital contributions
of our department. We hope to connect
our numerous subspecialties to promote
our department vision and mission as a
cohesive and collaborative faculty. Gasline
should be fun as well and so we want it to
serve as a platform to bridge department
social and academic events. It is still a
work in progress and as such we are open
to suggestions for changes people would
like to be made. I hope you enjoy this relaunch and the articles as much as I have.
Some excellent articles have been written
that range from medical standards by Dr
James Enns, to the global health initiative
by Dr Greg Klar and anesthesia centric
ACLS by Drs Kelvin Williamson, Marshall
M es s ag e f ro m t h e E d u cation S e c tor:
A
s always, there is a lot happening
in our department. In future
issues of Gaslines, look for discussion on our evolving UGME opportunities, Competency-Based education, and the
new and improved Ventis.
Today I would like to highlight our
Anesthesia-Centric ACLS. It has now been
through two sessions, and the reception
has been overwhelmingly enthusiastic.
Over the last few years, the APC has quite
appropriately recognized the need for anesthesiologists to be current with principles
of emergency management. This presented
a challenge, in that the de facto standard
for this is the ACLS course designed by the
Heart and Stroke Foundation. As all of us
who have taken the ACLS course know, it
is a course that is designed to address management of emergencies that present to
emergency rooms. Though not irrelevant
to our practice, it completely misses the
Tenenbein and James Bohn. Dr Arya, our
visiting professor, provided an insightful
piece on his spiritually guided path to
medicine and becoming an anesthesiologist as well as relaying his novel experiences and observations here as a visiting
consultant in Winnipeg, Manitoba. For
those of you that remember Dr Andrew
Sawka, he has graciously provided an update of how he has been doing in our popular “where are they now” segment. And
of course we have written articles by the
leaders of our department Drs Rob Brown,
Steve Kowalski, Craig Haberman, Trevor
Lee and our chair Dr Eric Jacobsohn. On
behalf of the staff involved in this Gasline
re-launch, our co-editors Sean Jardine and
Bruce Knoll, once again we hope you enjoy
our spring/summer Gasline 2014 edition.
Dr. Rob Brown
problems we really do see. Thanks are due
to to Kelvin Williamson, James Bohn, Marshall Tenenbein and Barry Bradley as well
as ACA’s Regina Kostetsky, Sean Jardine,
Jared Campbell and Mark Ratz who have
all put in a tremendous amount of work
to design our own U of M course. The
content is informed by the ASA’s anesthesia-centric ACLS supplemented by feedback
from our own quality assurance. Participants review online material on ACLS and
anesthesia-centric ACLS, and then come
to the hands-on session, where they rotate
through various roles in a team managing
four simulated anesthetic emergencies.
This is followed by a review and team
discussion of management principles.
This session has been approved for
the elusive Section 3 MoCert
points and is available on a
roughly monthly basis for 8
participants at a time. The
goal is to have everyone in the region certified in two years time, at which point we
will generate new scenarios and continue
with a biannual certification loop. Links for
registration can be found on the anesthesia
website.
Spring 2014
Page 3
A ne sth esia Cent r ic AC L S
specific to the situation at hand. Sometimes
the therapy is quite simple, at other times
the therapy can be cumbersome and complex.
As it is designed, the course allows the didactic review of material at the convenience
of the participant (a link to the material is
on the Anesthesia website). The practical
session is held at the Simulation Centre in
the basement of the Brodie Centre. The participants get a quick orientation to the site
and then all participate in the scenarios (as
a Leader, Observer, or active participant).
After each scenario, there is a debrief session, allowing for questions and reflection.
Critical Resource Management and adapting
the Team Concept are other cornerstones of
our program.
This is a very important step within our
group. For the first time, we are developing
a resuscitation standard, unique to Anesthesia. I truly feel that this standard is a level
above and beyond that of a generic ACLS
course. This is a positive step; and, in my
opinion, sets a high standard within our
department that reflects a dedication and
devotion to providing up to date, safe patient
care. Other departments will be envious of
our strength and steps we are taking to be
role models in resuscitative care.
The Future will involve building and
developing a number of different scenarios,
to ensure the program is always evolving.
Improvements based on participant feedback will also drive improvements in the
program. Of course, as ECC (Emergency
Cardiovascular Care) guidelines change,
our programming will reflect the most up
to date standards and guidelines. We are
also currently in the process of increasing
our teaching faculty. The requirement, at
present, is successfully completing a BLS or
ACLS Instructor program through the Manitoba Heart and Stroke Foundation, and/
or being experienced with Simulation and
developing simulation scenarios.
AC LS E duc ation Te am
Dr. Kelvin Williamson (Dir.)
Dr. James Bohn (Sim)
Dr. Marshall Tenenbein (Sim)
Instructors:
Mark Ratz
Sean Jardine
Jared Campbell
Regina Kostetsky
B LS E duc ation Te am
Dr. Barry Bradley (Dir.)
Instructors:
Mark Ratz
Sean Jardine
Jared Campbell
Regina Kostetsky
Jeff Kobe
Marshall Lawrence
Victor Duarte
Bela Gurik
Karen Babian
Amanda Eyjolfson
Faylene Funk
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An es t h e si a G r a n d Ro un ds
I
wanted to alert all of you of a
recent change to our Grand
Rounds format. We have
requested that the sessions be
recorded and pending lecturer
agreement, the session will be
available via video archive through a
link that is now active on our main
department (U of M Anesthesia)
website. Please note that certain
sessions may not be available via
this format (inappropriate topic for
broadcast, lecturer refuses webcast,
etc.). It is still expected that most
individuals will attempt to view the
sessions via the standard viewing
mode (on site) as an integral part of
these sessions is the ability to provide
immediate feedback and pose
questions. The interactive component
of our rounds is very important to
preserve. Lastly other sessions such
as subspecialty rounds and journal
club will not be available in this
fashion as they are not recorded
events.
The portal may be accessed by
clicking the link “Grand Rounds/
Video Archive” in the bottom right
hand corner of the website under
the area of “Current Events”. You
will also notice that for those unable
to attend the sessions live on site
or via the TeleHealth linked sites,
there is now the ability to logon to
the live webcast. This link exist on
the same page as the video archive
near the top of the page. Please
be aware that particular software
modifications may be required in
order to view the webcast (also see
the link for the software on the page
in the upper right hand side). The
portal will be protected with the
standard anesthesia website login and
passward.
Live
more inclusive viewing of most
sessions.
As this is new for us there may be
a few technical issues to work out.
Please let us know how the system
works for you and as usual we
welcome any feedback.
Dr. Joel Loiselle
I have clarified with the Royal
College that the sessions viewed
either archived or via live webcast are
eligible for MOCOMP Category 2
credit. This is because we are unable
to provide any interaction between
staff and the presenter during
question period in the present. We
are looking into possibilities to
accomodate this in the future.
I hope this advanced use of
technology enhances your CPD
experience. This format should allow
Mess ag e f rom t h e d e pa rtme nt he ad: cont. from page 2
faced with yearly budget reductions
in the last two years. Further budget
reductions are expected in the next two
years, which will require us to potentially examine how we deliver and pay
for our educational programs.
From the Winnipeg Regional Health
Authority perspective, our sites continue to operate very effectively. The Anesthesia Program continues to deliver
exemplary care and have demonstrated
cost consciousness. Anesthesia driven
slate cancellations are exceedingly
low. We are working very closely with
our surgical program colleagues to
assure the appropriate matching of
slates versus required clinical volume.
This process is one that continuously
evolves, but I am pleased that expertise and resources of the Anesthesia
Program are being used, in a collaborative fashion with other programs, to
assist in this matter. A major challenge
that has to be addressed in the clinical
area is the lack of an electronic patient
record (EPR). EPRs, with all their limitations and frailties, are increasingly
required for effective clinical delivery; they are
seminal to quality assurance outcome measurement, and for research. We are in discussions
with the Region and Government to develop a
substantive business case for introduction of this
technology.
I want to take this opportunity to invite all
faculty and alumni to join us at the Alumni
Reception at the CAS. I also want to use this
opportunity to wish you an enjoyable summer
and look forward to your ongoing to commitment and involvement in the Department.
Spring 2014
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2014 Annual Department of Anesthesia Gala:
Celebrating completion of training for PGY 5’s and Fellows
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Spring 2014
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T H E
Global Health
P R O J E C T
Dr. Greg Klar
caused by well-intentioned
organizations as a result of
lack of understanding and
appreciation of the complexity
of providing aid.
F
oreign aid is defined as a
voluntary transfer of supplies,
knowledge or service from one
country to another (Carol Lancaster
2007). Global health is an expanding
field in medicine that is gaining
momentum seen by an increase in
governmental spending, increase
in number of health care workers
traveling abroad and a increase in
postgraduate and undergraduate
involvement. At the University
of Manitoba, we have seen the
same increase in awareness and
enthusiasm in global health. Over
the last several years many residents
have traveled abroad to assist in
humanitarian work.
To help unravel and
understand issues that pertain
to effective aid delivery, the
Department of Anesthesia
is developing a global health
curriculum. The curriculum
will be directed towards
residents who will take part
in humanitarian projects. The
curriculum will explore the
history of foreign aid, navigate
through types of foreign
assistance, consider several
public health topics, critically
appraise aid organizations and
discuss ethical aspect of global
health. The Anesthesia U of M
website will provide a list and
description of foreign experiences to better
match the trainee. Helpful preparatory
information will be available to make the
trip safe, enjoyable and above all to do no
harm.
We look forward to working with you,
and welcome any input and feedback that
you might have.
Providing helpful foreign aid is
difficult and often carries many
ethical and logistical considerations.
We have seen many disasters
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A nest h e sia Sta n da r d s:
M
edical documentation facilitates enhanced patient care
through communication
with others on the health care team and is
paramount to the continuity of care.
Risk-management paradigm handles
failure to document relevant data as a
breech of care standards. However, even
the Anesthesia Standards Chair’s highly
revered advice is often truncated to the
admonition that “you guys ought to write
more”.
Nevertheless, lengthy notes are not
All H a i l the C hie f
I
t’s hard to believe that the 2013/2014
academic year is already coming to a
close. The past few months have
been busy for the residency
program, with accreditation,
CaRMS, and end-of-year
activities all occurring within
a relatively short period
of time. We are all
very pleased that our
program has once
again received full
accreditation. Many
predictably superior. Indeed, quality offsets
quantity in the medical record.
Documentation of risk vs. benefit is a
widely accepted concept with regard to
consent issues, but it is particularly important considering the principles of medical
decision analysis. Many anesthetic records
contain documentation that “risks were
discussed”, and even contain a litany of particular vulnerabilities, but lack the corollary
that any attention was given to potential
benefits, or indeed, the risk of not receiving
the intervention or treatment. A simple
written summary of the decision algorithm
demonstrates an implicit thought process.
In standards review, or even litigation, a
physician may be shown to have made a
wrong decision, but could not be judged as
negligent given validation by a prudently
considered cognitive process.
More importantly, recording the use of
clinical judgment when making critical
decisions is fundamental. Prudent use of
clinical judgment is predicated on assessment of the clinical situation and provision
of a congruent response. Such a summary in the chart is advantageous because
reasonable consideration of management
alternatives infers clinical judgment and is
axiomatically inconsistent with negligence.
thanks to Dr Haberman and Tara De Castro for all their hard work! The CaRMS
match also went very well this year, and we
look forward to welcoming the new PGY1s
to the resident group.
As we welcome the new residents, we must
also say goodbye to the current PGY5s.
Congratulations to the graduates Mullein,
Daniela, Purnima, Erika, Mehdi, and Alex,
we’re grateful for the many contributions
that you’ve made to the residency program
over the past five years, and we look forward to having you as our attendings next
year! Special congratulations to Purnima,
recipient of the Resident of the Year award,
James Enns M.D.
Physicians derive immeasurable medico-legal benefit by documenting justification for their decisions. Jurisprudence
recognizes that clinical judgment is based
on both subjective and objective factors
from the encounter with the patient and
the “primacy of the on-site observer” is
routinely emphasized during legal proceedings. The benefit of the doubt is given
to the physician who actually interviewed
and examined the patient since they had
access to ephemeral details and subjective
clinical data (vocal tone, body language
and facial expression) that are customarily never recorded in the medical record.
Expert witnesses implicitly acknowledge
that no one else had that direct experience with the patient and must carefully
deliberate this premise while determining
whether the standard of care was met.
This benefaction is lost without clinical
notes indicating prudent reflection on
management alternatives and the associated contexts that have influenced the
process.
Simply stated, recording management
options in the medical record is beneficial, but explanation of the rational for
selecting a particular option catapults its
fundamental value.
and many thanks to Mullein for all her
hard work as Chief Resident.
A number of resident activities are already
in the works for the next academic year.
Our annual resident retreat will be held in
September 2014. Residents continue to
show significant interest in international
outreach, and Raegan Cleven will go to
Nicaragua with Operation Walk in October 2014. Resident involvement in UGME
teaching has expanded over the past year,
and we will continue to lead Med 3 teaching sessions in both the classroom and
CLSF setting. We anticipate another great
year in 2014/2015!
Spring 2014
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Re s i d e nt P ro g r a m U p date :
I
t has been a busy but exciting time for
the Postgrad office of late. Most notably
the program underwent its accreditation
review in February of 2014 which turned
out very well for us. The recommendation
of the accreditation survey team was full
accreditation with no noted weaknesses.
This recommendation has been forwarded
to the RCPSC Anesthesia Specialty committee and we will receive the official report
in June. Preparation for the accreditation
was a tremendous amount of work and
many thanks and much credit go to Tara
De Castro for her efforts in preparation for
accreditation. Likewise, many thanks to the
anesthesia faculty whose efforts in resident
education and ongoing commitment and
contributions to the program were noted
at accreditation as a great strength in our
Department. Your time, effort and commitment are greatly appreciated both by me as
well as all of the residents.
February also was CaRMS month and
we were very pleased both with the process
and our match result. Dr. Eric Sutherland
serves as the chair of the CaRMS committee
and along with Tara they have done a terrific job in streamlining our CaRMS process.
This year the PGME office granted us 5
spots for Canadian Medical graduates as
well as one spot for an international medical
graduate. We are very happy to welcome to
the Department for the next academic year
Ethan Bohn, Andrew Geisheimer, Robert
Hardy, Jeffrey Heinrichs, Calvin Loewen
and Daniel Rodrigues.
The 5th year residents are currently
studying for the oral exam component of
their exam having completed the written
exam in early April. The Oral exams will
occur in the first week of June and we wish
Erika, Daniela, Alex, Purnima, Mullein and
Mehdi the best of luck and congratulate
each of them on completion of their 5 years
of residency.
We recently celebrated both the 5th year
residents graduation as well as a number
DR. CRAIG HABERMAN
of other faculty awards at the Department
Gala on April 12. I would like to extend
congratulations and thanks to all of the
teaching award recipients and nominees
on a job well done. A special word of
congratulations also goes out to Dr. Purnima Rao who was this year’s recipient of
the Douglas B. Craig Resident of the Year
award – well done Purnima.
attending the CAS conference in St. John’s
we are excited that a number of residents
have been accepted to present their research and would encourage you to come
and support them at their presentations.
Information with regard to who is presenting and when they will be presenting
will be forthcoming on the department
website.
On the educational horizon are a couple
of changes. From a University perspective
VENTIS PGME will roll out effective in
the very near future so that all of PGME
will use this program both for scheduling
as well as for evaluations. From a Royal
College standpoint CaNMEDS 2015 will
be introduced next year which will require
us to reshape some of our curriculum.
More information on the changes and effect that will have for our program
specifically will be forthcoming as the RCPSC releases
more information to
us. The RCPSC is also
moving toward a competency based approach to
medical education – this
transition will happen
over the course of the next
few years, and the full ramifications of this with regard
to how anesthesia education
will look or change are not
yet known. A couple of Anesthesia programs – Ottawa and
Halifax - are piloting competency
based programs already and these
will presumably help to shape
from a national level how
competency based
components
will be implemented into
Anesthesia
residency
training.
For those
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And r ew Sawk a : Wh e r e A r e Yo u N ow ?
It’s hard to believe that it’s been 11 years
since I left Winnipeg. When I think about
HSC and St. Boniface and the people I
worked with there it seems like it was just a
short time ago.
When I was considering moving out
to Vancouver in 2002, it was common
knowledge that the only places in Canada
that didn’t need anesthesiologists were
Ottawa and downtown Vancouver and
Vancouver specifically was a “closed shop”
. So… I skipped the big hospitals and
started sending letters to the anesthesia
departments in Langley, Burnaby,
Richmond and the other suburbs. It was
an email from another U
of M alum that changed
my plan. Fred Clark
(remember him) had
heard that UBC Hospital
(a small 6 OR community
hospital) was suddenly
short staffed and looking
for locums, so I called the
head there and was offered
a locum over the phone.
That very quickly led to
some locums at Vancouver
General Hospital and
an unexpected offer of
a staff position at VGH.
The regional anesthesia
teaching I received at the
U of M was in large part
responsible for this offer
as I was hired specifically to help start
a regional anesthesia program out here.
In the last 11 years I have been fortunate
enough to be part of a lot of exciting
programs here at VGH.
The VGH anesthesia group reminds me
a lot of the Winnipeg anesthesia groups
of the late 90’s. It is a group practice/
cost sharing arrangement with defined
subspecialty groups and a high standard
of clinical practice. In addition to
helping launch the regional anesthesia
program I have been a part of the liver
transplant group almost from the time I
started here. A year later I was asked if
I wanted to be the anesthesia fellowship
director for VGH and continued in this
role until 2010. This led to various other
administrative roles including the clinical
director for the department of anesthesia
from 2010 to 2013. In September of
2013 I was asked to take on the role of
Medical Director of Perioperative Services
for Vancouver Acute (VGH and UBC
Hospitals). Perioperative services include
the Anesthesia consult clinic, the operating
rooms, and postoperative care area and
my role includes allocation of resources
(including OR time), strategic planning
and quality assurance.
One of the things I have enjoyed most
about working at VGH has been the
opportunity to be one of the founding
members of the Regional Anesthesia
Research Team (RART). This is basically
a small group of hobby researchers getting
together with residents and fellows to
carry out small scale projects answering
simple but relevant clinical projects with
little or no budget. Since we are all hobby
researchers with absolutely nothing to
gain from this endeavor we decided when
the group was founded that we would
avoid complicated time consuming
projects and that if the RART became
too stressful or anyone became too
emotionally invested in this work that
we would disband the group and quit
research. Despite our modest goals we
have generated around 20 publications
in the last three years and since we are all
still having fun RART lives.
The most important part of my life
is of course my family. My wife
Judy and I have three beautiful
daughters; Justine 5, Claudia
3 and Andie 18 months. We
also have three cats (not the
original plan) and a dog. We
both live close to work (22
minute walk for me and 25 for
Judy) so we don’t waste any
time commuting at all. We
love living in Vancouver, it’s a
beautiful city with great winters
and 600 sushi restaurants, but I
have to admit we haven’t taken
advantage of all things that this
city has to offer. We only go
skiing once per year, but we do
spend as much time as possible
at our cottage in Qualicum
Beach. The highlight of our year
is the time spent there in the summer. It
never gets as hot near the ocean as it does
at the Manitoba lakes but the days are
long, sunsets spectacular and our beach
virtually empty even on long weekends in
the summer.
I wish all the best to my old friends and
colleagues in Winnipeg. I miss you all.
Spring 2014
Page 11
the new k i d s on t h e b loc k
Dr. Robert Hardy, PGY1 Anesthesia
Robert Hardy is a born and raised Manitoban, and graduated from the University of
Manitoba, Faculty of Medicine. Prior to starting medical school, Robert was a licensed
Pharmacist, working at Cancer Care Manitoba for 2 years and briefly at Concordia
Hospital. He played competitive golf during high school, and still enjoys playing
recreationally. He also enjoys staying physically active by running, cycling and going to
the gym.
Dr. Ethan Bohn, PGY1 Anesthesia
Ethan grew up in Winnipeg, Manitoba. He has an undergraduate background in
science, and completed his medical degree at the University of Manitoba. In his spare
time, he enjoys playing basketball, road cycling, and traveling. He looks very forward
to meeting everyone in the department and beginning his residency.
Dr. Daniel Rodrigues, PGY1 Anesthesia
Daniel was born and raised in the Seven Oaks community in Winnipeg, Manitoba.
After completing his undergrad degree at University of Manitoba, he attended Ross
University School of Medicine in the Caribbean, where he completed his basic medical
sciences and then moved to the US to complete his clinical rotations in Miami and
Chicago. Daniel is a huge sports enthusiast. His dream growing up was to be the QB for
the Blue Bombers but realized it would be a long shot, so instead became one of their
biggest supporters. He enjoys spending time outdoors and is a huge foodie. In his spare
time he enjoys trying new restaurants and cooking new dishes. Daniel is honored and
excited to be part of the Anesthesia Residency Program.
GasLine - A P u b l i c a t i o n o f t h e D e p a r t m e n t o f A n e s t h e s i a a n d P e r i o p e r a t i v e M e d i c i n e
welco me 2 0 1 4 - 2 0 1 5 P G Y 1’ s
Dr. Calvin Loewen, PGY1 Anesthesia
Calvin was born and raised in Edmonton and received a Bachelor of Science degree
with a Minor in Music from the University of Alberta. Prior to entering medical
school Calvin worked as a Respiratory Therapist, which gave him some initial
exposure to the field of Anesthesiology. Although he loved that job, he was ready to
pursue his schooling further. He then moved to Calgary where he completed his
medical degree. Outside of medicine he enjoys playing the trumpet and bagpipes,
and has a love for cooking. During the summer he enjoys playing Ultimate Frisbee.
Dr. Andrew Geisheimer, PGY1 Anesthesia
Andrew is from Vancouver, British Columbia. Many people assume that he
must not like winter but his time during medical school in Kingston at Queen’s
University has prepared Andrew for life in Winnipeg. Outdoor recreation has
always been very important to him, especially in distance running and road
cycling. Andrew hopes to enter some running races this fall and take advantage
of the city cross-country ski trails in Winnipeg next winter. He also enjoys travel,
cooking, photography, and reading. Prior to medical school, he completed his
B.Sc. and M.Sc. in chemistry at Simon Fraser University. Andrew is thrilled to
be starting a new adventure in Winnipeg and joining the Anesthesia Residency
Program.
Dr. Jeffrey Heinrichs, PGY1 Anesthesia
Jeffrey grew up in Calgary, Alberta and moved to Edmonton where he
completed both his undergraduate and medical education at the University
of Alberta. Jeffery enjoys cycling, skiing, and music of all sorts. He looks very
forward to spending some time bike touring this spring before making the move
out to Winnipeg.
Spring 2014
Page 13
the Research Quarter
project. We are indeed very fortunate to
have someone of her caliber to support us.
Secondly, there have to be “boots on
the ground” to help in recruiting patients,
conducting clinical studies and chart
reviews. There are a number of research
assistants working in the Department
providing support on various projects.
Mr. John McVagh, Mr. Alex Villafranca
and Mr. Hessam Kashani provide support
on various clinical research projects
at St. Boniface Hospital. At the Health
Sciences Centre, Ms. Regina Legaspi and
Ms. Marita Monterola assist with clinical
studies. Each summer Departmental
faculty hire several students and take
part in the BScMed program to support
undergraduate research.
R
esearch and the creation of new
knowledge is crucial for the
specialty of Anesthesiology to
grow and develop. As Dr. Jacobsohn
has reiterated numerous times, if we are
just practitioners of anesthesia, we risk
becoming a guild, but as researchers, we
expand the boundaries of our specialty
and create a true profession.
Over the past eight years, the
infrastructure to promote and support
research in our Department has
expanded considerably. First and
foremost is Ms. Linda Girling, the
Research Administrator. She has had
many years experience conducting
both small and large animal research as
well as clinical studies. Her curriculum
vitae is very impressive with over 80
publications. She is knowledgeable in
statistical analysis and the preparation
of both posters and manuscripts, and
has extensive experience with grant and
ethics submissions. She is willing and
able to provide support in any phase of
the research endeavor be it planning,
running, analyzing or writing up a
Finally, nothing can occur without
money. The Academic Oversight
Committee (AOC) is a sixteen person
committee formed from broad
representation within the Department.
This group meets twice a year, to
review and consider applications for
research funding from members of our
Department. The AOC can award grants of
up to $10,000 which act as “seed money”
for research projects. In discussion with
colleagues from across the country, this
is a unique institution and the envy of
other Departments. It has been successful
in promoting research and the academic
profile of the Department. At the last
meeting of the Canadian Anesthesiologists’
Society in 2012, we had a total of 18
papers, lectures, case reports presented at
the meeting, which was the single largest
representation from the University of
Manitoba. AOC grants either alone or
in part have been responsible for eleven
publications of original research in peerreviewed publications. In addition, AOC
grants have been crucial in allowing us to
participate in multicenter trials such as the
BAG-RECALL Study, TRICS III, POISE
and VISION studies and the upcoming
PODCAST and ISOS studies, resulting in
publications associated with these studies.
In today’s evidenced-based world there is a
need for large, randomized clinical trials to
answer essential questions in our specialty
and participation in these clinical trials is
crucial.
However, serious research requires
serious money and various members of
our Department have been successful
in competing for and obtaining external
grants for research. Recently Dr. Alan
Mutch and his colleagues in the Canadian
North Concussion Network (CNCN)
were awarded two grants, one from
the Manitoba Health Research Council
Partnerships Program and the other from
Health Sciences Centre Foundation to
support their work with MRI imaging in
concussion. Dr. Ruth Graham received
funding from Manitoba Institute of Child
Health for her bench animal studies in
ARDS. Dr. Duane Funk has been awarded
a Subspecialty Award from the Canadian
Anesthesiologists’ Society for his project in
cerebral oxygen saturation monitoring and
peri-operative outcomes.
The University Department of
Anesthesia is committed to promoting
and supporting the academic mission and
research endeavours of our faculty.
Dr. Stephen Kowalski
GasLine - A P u b l i c a t i o n o f t h e D e p a r t m e n t o f A n e s t h e s i a a n d P e r i o p e r a t i v e M e d i c i n e
A n est h es i a E qu i p m e n t, D ru g/S upply and Ac quis itions Rep ort
F
or the 2014 fiscal year, there are a number
of ongoing equipment and drug projects
that UM/WRHA Anesthesia is involved in:
1
Spinal and epidural trays: The region is
continuing to work with WRHA Logistics services on improving the spinal and
epidural trays for Anesthesia use within the
WRHA.
2
Intravenous supplies and volumetric
pumps: The UM/WRHA Anesthesia
Program is involved in an integral manner with the provincial project to renew the
intravenous supplies and volumetric pump
contracts. The next phase of this project will
involve the introduction of new intravenous
lines and software upgrades to the Baxter
Colleague volumetric infusion pumps.
3
WRHA medication shortage: As you
are aware, there are ongoing shortages
of various Anesthesia medications in
Canada. The UM/WRHA Anesthesia program continues to work with Pharmacy Logistics to contingency plan for these shortages.
4
Specialized and basic equipment
2013/2014: The acquisition and installation of Philips Vital Signs monitors
at SBH, and acquisition and installation of
difficult airway equipment at HSC are proceeding.
5
Specialized and basic equipment
2014/2015: Mr. Reid McMurchy and
I attended the specialized and basic
equipment meetings for 2014/2015, on your
behalf. We await the funding announcements for specialized equipment awards
based on our submissions.
6
Provincial Surgery Information System
(SIMS) Advisory Team: The Equipment program is now actively involved
in the strategy and planning for the WRHA
regional OR computerized management
system, with a future goal of incorporating
an Anesthesia Information Management
System (AIMS) into this project.
Thank you for your continued support of the Equipment and Drug/Supply and
Acquisitions program.
U M / WR H A C l in i c al Ope rations Re port
In planning for the 2014/2015 academic
year, the Clinical Operations program
is working with UM/WRHA Anesthesia
Leadership in reviewing new staff
appointments and in reviewing current
and future UM /WHRA Anesthesia
Program clinical human resources needs.
Incorporating incoming Anesthesia
Fellows and locum staff into the clinical
services map is also a priority of the
Clinical Operations Program.
The Clinical Operations program is
collaborating with the WRHA Surgery
program in taking a closer look at operating
room slate utilization. Together, we are
working on methods to improve transparency
and efficiency in overall slate utilization.
Dr.Trevor Lee
Head, Clinical Operations
The success and efficiency of having a
centralized system in place for Clinical
Operations HR management was well
demonstrated with the recent flooding at
St. Boniface Hospital. Thank you to all of
the members of the UM/WRHA Anesthesia
Program at all clinical sites for helping to
minimize the impact of this occurrence on
patients and their families.
Spring 2014
Page 15
Welco me N e w R e s e a rc h A s s i s ta n ts
Dr. Eric Jacobsohn, Professor and Head, and Dr. Stephen Kowalski, Professor and Associate Head Research
and Academic Affairs, are pleased to announce the recent hiring of three research assistants in the department.
Hessam Kashani
previously practiced general medicine in Iran until moving to Canada in
2008. Mr. Kashani recently completed his MSc in Physiology at the University of Manitoba.
Regina Legaspi
previously practiced obstetrics/gynecology in the Philippines until emigrating to Canada in 2010. Prior to her employ in our department, Ms. Legaspi
worked in the Department of Surgery at the University of Manitoba on the
VISION trial.
Marita Monterola
previously practiced pediatric medicine in the Philippines, emigrating to
Canada in 2008. Ms. Monterola recently worked at Health Sciences Centre
conducting clinical research studies in Nephrology.
Mr. Kashani and Ms. Monterola will be conducting the PODCAST trial at St. Boniface Hospital and Health
Sciences Centre respectively. Ms. Legaspi is providing research support on various research projects at
Health Sciences Centre.
GasLine - A P u b l i c a t i o n o f t h e D e p a r t m e n t o f A n e s t h e s i a a n d P e r i o p e r a t i v e M e d i c i n e
A nno u ncem en t s
Dr. Hilary Grocott has been appointed
by the Canadian Anesthesiologists’ Society
Board as the new editor-in-chief, Canadian Journal of Anesthesia, for a 5-year term
effective January 2014.
The Board of Governors of the University of Manitoba has recommended Dr.
Stephen Kowalski be promoted to Full
Professor, effective March 30, 2014
Dr. Archie Benoit and Dr. Trevor Lee have
assumed Co-Site Leadership at the Misericordia Health Centre April 1, 2014.
Dr. Marshall Tenenbein has assumed
the position as Undergraduate Program
Director, University of Manitoba, Department of Anesthesia, effective April 1,
2014. He has also assumed the position
of the Undergraduate Medical Education
(UGME) Site Coordinator at the Victoria
General Hospital.
Dr. Vincent Wourms has assumed the
position of Neuro Anesthesia Fellowship
Director, University of Manitoba. Effective
January 1, 2014.
tice on May 12 in the WRHA Anesthesia
program based initially at St. Boniface
Hospital.
Welcome Dr. Saurabh Nagpaul, a Visiting
Professor from London, UK. Dr. Nagpaul
started clinical practice at St. Boniface
Hospital on May 22.
Dr. Chris Christodoulou won the “Outstanding Mentor and Role Model Award”
as an Educator of the Year nominee. Dr.
Duane Funk was also nominated.
Dr. Alan Mutch was recently awarded
two Research Grants on which he is the
Principal Investigator. The first grant from
the Manitoba Health Research Council
(MHRC), the second was awarded by the
Health Sciences Centre Foundation. These
research funds are associated with the
establishment of the Concussion Research
Group at the Univ. of MB, in collaboration
with the Pan Am Concussion Clinic and
with the KIAM at HSC.
Dr. Diane Biehl was awarded the rank
of Professor Emeritus at the University of
Manitoba in 2014.
Dr. Ainsley Espenell has assumed the position of Postgraduate Medical Education
(PGME) Site Coordinator at the Children’s
Hospital, effective March 1, 2014.
New Staff
Welcome Dr. Virendra Arya, a Visiting
Professor from the Postgraduate Institute
of Medical Education and Research in
Chandigarh, India.
Vincent Wourms, Assistant Professor
Kristin McCrea, Assistant Professor
Pediatric, January 2014
Adult, July 2013
Ian McIntyre, Assistant Professor
Pediatric, July 2013
Greg Klar, Lecturer (Locum)
Adult, July 2013
James Bohn, Assistant Professor
Adult, July 2013
Virendra Arya, Visiting Professor
Cardiac, August 2013
Suresh Pandurangan, Visiting Professor, May 2014
Saurabh Nagpaul, Visiting Professor,
May 2014
New Babys
Patricia Mykytiuk had a Baby girl, Anya
born July 18, 2013 8lbs 12oz.
Retirements
Dr. Peter Duke – March 31, 2013
Dr. Suzanne Ullyot – June 1, 2013
Dr. Brian Pickering - June 2014
Fairwell Dr. Fahd Al-Gurashi, returning to Saudi Arabia - June 2014
Ryan Brinkman, Assistant Professor
Welcome Dr. Suresh Pandurangan, a
Visiting Professor from Bangalore, India.
Dr. Pandurangan started clinical prac-
Adult, July 2013
Spring 2014
Page 17
Dr . Vi r endr a A rya : E x p e rie nc e s in the W RHA
I
was sitting alongside Dr Amit
Chopra in the hospital OR lounge
in Concordia when he asked me if I
could write something for Gasline about
my experiences in Winnipeg and compare
them with those in India. I was undecided
what to write as experiences of anyone depends how he perceives them. So I decided
to start with my background so that the
reader will have opportunity to understand
my point of view about these experiences.
I was born on 24th June 1969 in a remote
village Johru of Hamirpur district in
Himachal Pradesh in India. My grand
father was conventional medicine doctor
(Ayurveda) and wanted me to be a doctor
as he considered this a very noble profession to serve the humanity, as commercialization of this profession had not
taken place in India in those days. Both
my parents were schoolteachers and their
job was transferable from place to place.
Hence, my initial schooling took place at
various remote areas of Himachal Pradesh
and I developed special interest in teaching perhaps due to inheritance of teacher
genes. I did my BSc from Government
Degree College Hamirpur in 1985. I had
a special interest in physics and wanted to
become engineer; however, as luck would
have been I got selected in Indira Gandhi
Medical College, Shimla through entrance
test in 1986 and completed M.B.B.S (Bachelor of medicine and bachelor of Surgery)
including one year compulsory rotational
internship training in June1992. Now
when I look back into the past, I consider
this undergraduate training period and
stay at Shimla as the best period of my
life. Shimla is the town established by the
British on the foothills of mighty Himalaya
Mountains and has a very scenic beauty
and a very nice climate throughout the
year. This town used to be the summer
capital of British rule in India before 1947
and now it is capital of Himachal Pradesh.
One of my medical school mentor Dr Beli
Ram used to go for Eye camps and I used
to accompany him. This created special
interest for ophthalmology and I did sixmonth House job in it from July 1992 to
December 1992. In those days Postgraduate Institute of Medical Education and
Research (PGIMER) Chandigarh and All
India Medical Institute of Medical Sciences
(AIIMS) Delhi were two most prestigious
postgraduate medical training institutes
in India and doing postgraduate specialist
training from either of these institutes used
to be the dream of every medical graduate.
(These institutes are still considered to best
in India). In January 1993, I was selected
for postgraduate training in Anesthesia at
PGIMER Chandigarh. I wanted to try my
luck again for ophthalmology next year by
quitting it; however, my father advised me
to continue quoting a very famous quote
from Hindu sacred book ‘Gita’ that “As human beings we only have the right to work
hard and sincerely for our aspirations, the
results are in God’s will, and we should
accept and let the God’s will prevail.” So
I continued in Anesthesia specialty and
never had to regret this decision till date! I
was awarded MD anesthesia degree with
distinction ‘Bronze Medal’ in December
1995 and after completing six years of
training in anesthesia as junior resident for three years and senior resident
for another three years, I was selected
as Assistant Professor Anesthesia at
PGIMER Chandigarh in February 1999
and continuing till date there. During
early nineties the anesthesia training
at PGIMER was recognized in UK and
PGIMER trained used to get registrar
position in anesthesia there under over
seas trained doctors scheme (OTDS). I
had a strong desire to train outside India
soon after I completed my post graduation from PGIMER Chandigarh and got
an offer from Sandra Wood who used to
be OTDS coordinator in UK. However, I
could not join due to my family commitments from being an only child.
As a faculty in PGIMER Chandigarh
I got ample opportunities to refine and
improve my skills in practicing and
teaching anesthesia. As PGIMER faculty
I visited various overseas institutes for
learning and training purposes including Sir Charles Gairdner Hospital Perth,
Westmead Hospital Sydney, Austin
Health Melbourne, UCSF Moffitt Long
Hospital San-Francisco, Virginia Commonwealth University Hospital Virginia.
In 2009 an anesthesia resident exchange Programme for one month
between university of Manitoba and
PGIMER Chandigarh was started after
Prof Eric Jacobson and his team visited
PGIMER Chandigarh. In May 2012 I
along with our cardiac surgeon visited
Winnipeg on our way to US and interacted with anesthesia residents. Subsequently residents from both sides were
exchanged for one month. Professor Eric
Jacobson offered me to have experience
of work culture here and that is how I am
here as locum staff at present.
GasLine - A P u b l i c a t i o n o f t h e D e p a r t m e n t o f A n e s t h e s i a a n d P e r i o p e r a t i v e M e d i c i n e
I have very beautiful experiences to
share from my stay here. I have just felt as
one of the family member from day one
and never felt home sick despite being
alone here. I admire the way I was exposed
to the health care system here and opportunities were given to understand this system gradually. The anesthesia department
works in a very organized way here. There
are well-defined protocols, EPR system,
implementation of WHO check list, professionalism of all the health care workers,
work evaluation and feedback system on
ventis etc. all these are very impressive.
Here once you have signed off, you can
switch off your self from the hospital and
that is very important for your personal as
well as family life and other social activities.
The skill of surgical specialties in
laparoscopic procedures and joint replacement arthoplasties is amazing and
many critically sick patients undergo these
procedures safely as surgical procedures
are done in a very precise way without
much alteration in body homeostasis.
Well-structured postoperative pain
management facilities are highly impressive. Working of staff members at various
hospitals (at least two) has helped to keep
the standards of health care system more
or less uniform in all WRHA hospitals.
The professionalism of nursing staff and
ACAs is highly laudable. This is something
I have seen in all the developed nations
that I have visited so far. There is very
efficient team approach and communication here that are important for the success
of any system that believes in delivering
excellent results.
Dural puncture and epidural blood
patch are frequent here. I have not seen
anyone giving blood patch in past 15 years
in my institute and this difference appears
to be due to the differences in the type
of the population we deal with. Majority
of patients in India are more sensitive to
narcotics as compared to here. Aortic dis-
sections and aneurysms are more common
here while more advanced and late presentation of cardiac disease is more common
in India due lack of uniform health care
system. In India, PGIMER Chandigarh
as a tertiary care center performs around
60,000 to 65,000 surgical procedure in a
year, so the exposure to a variety of pathologies is unimaginable there. We have
now super-specialty concept in anesthesia
like cardiac anesthesia, neuro- anesthesia,
pediatric anesthesia, trauma anesthesia
etc. in India and we are so busy in these
individual specialties that we don’t find it
easy to rotate in all specialties. In cardiac
anesthesia we deal with all range of pediatric to adult cases and do around 1700 to
1800 cases in a year. Cardiac anesthesia
and surgical Programme is well structured
in our institute as well. Equipment wise
both places are similar except we do not
use multichannel infusion pumps and the
type of arterial cannula that we use here
in Winnipeg. In PGIMER Chandigarh
we have two 3D echo machines in 2 ORs
as 30-40% of our practice is in pediatric
cardiac surgery. One important difference
that I observed is more incidence of postoperative coagulopathy and re-exploration
rate here as compared to my experience in
India; may be due to differences in patient
population and management strategies.
The fast tracking in cardiac anesthesia
here is impressive; however, final discharge
from hospital appears same about 4-6 days
in both places for straightforward cases.
Very critically sick patients die in 6-7 days
in PGIMER Chandigarh and I feel in 6-7
months here after a very high resource
intensive ICU management.
Cardiac surgery in Winnipeg faces
more cancellations, OR holds and sudden alterations to the operative list that is
unheard of in our advanced cardiac center
in PGIMER Chandigarh. There, following
week cardiac lists are presented and discussed on Saturday meetings and emergency cardiac procedures are done separately in dedicated ORs by the emergency
cardiac anesthesia team. We never work
alone in cardiac ORs, or in fact any ORs
in PGIMER Chandigarh and we always
have residents with us. My Anesthesia
department in PGIMER Chandigarh India
constitutes of about 50 faculty members,
150 anesthesia residents and about 30 post
MD anesthesia super-specialty DM fellows
at present. Manpower is not a problem per
se in India.
Grand rounds are impressive academic events here that I enjoy the most. We
have similar events by name of seminars
back in India. Residency program at both
places are very demanding except with one
difference. In PGIMER Chandigarh, residents in anesthesia get a huge amount of
exposure under one roof and do not have
to go to various hospitals to complete their
residency. I have found Winnipeg anesthesia residents enthusiastic to learn. PG 4
and 5 residents are well read at both places.
In summary there is always scope to
learn and share wherever you work. I am
always of the concept that in medicine we
are dealing with God’s most complex and
amazing creation i.e. human beings. We as
a part of creation can never fully understand Creator’s creation. Hence, there is
always scope for more learning and no
scope for macho attitude. Medicine can
only be practiced with a most humble and
a team spirited attitude. I feel there should
always be scope for collateral thinking
when we make and follow protocols because pathophysiology in human beings is
very versatile. I have always found unique
strengths and beauties in all the systems;
wherever, I have worked so far. These
mutually beneficial exchange programmes
open new horizons of wisdom, experiences
and opportunities to improve upon and
share experiences for all concerned whether developed or developing.
Dr.Virendra Arya
Spring 2014
Page 19
THE LAST PAGE
EDITOR IN CHIEF: DR. AMIT CHOPRA
CO-EDITORS: BRUCE KNOLL
SEAN JARDINE
Spring 2014
Page 20